UROLOGY, Volume 64, Number 6: Page 1267,
December 2004.

Circumcision in Adults: Effect on Sexual Function

TO THE EDITOR:

Senkul et al.1 surveyed young men of military age in
Turkey before and after elective circumcision. They reported,
“Adult circumcision does not adversely affect
sexual function,” although a significant increase in
ejaculatory latency times was recorded. Unfortunately, older
men, in whom problems may be more likely to occur, were not
included in the study.

This survey was carried out in Turkey. Male
circumcision is deeply woven into the fabric of Turkish
society.2 Turks consider that
one is not a man until one is circumcised.2 Culture is a confounding factor in
studies regarding circumcision,3
and this study does not escape the influence of culture.
Goldman4 reports:

Defending circumcision requires minimizing
or dismissing the harm and producing overstated medical
claims about protection from future harm. The ongoing
denial requires the acceptance of false beliefs and
misunderstandings of facts. Cultural conformity is a major
force perpetuating non-religious circumcision, and to a
greater degree, religious circumcision. The avoidance of
guilt and the reluctance to acknowledge the mistake and all
that that implies help to explain the tenacity with which
the practice is defended.

The claim that “adult circumcision
does not adversely affect sexual function” is a
value judgment rooted in the culture of Turkey.1 Other researchers may consider an
increase in ejaculatory times to be adverse.

Other authors’ findings that
circumcision does affect sexual function are helpful.
Earlier work by Winkelmann5
showed that the foreskin is the site of the mucocutaneous
region and that closely packed end organs extend from the
distal end of the prepuce back to the hairy skin. Winkelmann
characterized this as a specific erogenous zone.
Taylor et al.6 subjected
the prepuce to anatomic examination. They found a previously
unknown structure, which they called the ridged band,
of highly vascularized and innervated tissue just inside the
tip of the prepuce and near the mucocutaneous boundary.
Penile nerves provide sensory input to both the central and
sympathetic nervous systems.7
Waldinger7 reports that an
ejaculatory circuit exists in the central nervous system that
controls ejaculation. Winkelmann5 observed, “Certain pathologic
states might be explicable on the basis of diminished or
augmented cutaneous nerve supply.” The excision of the
ridged band nerve plexus by circumcision and consequent
diminishment of sensory input would explain the increase in
ejaculatory times reported by Senkul et al.1

Senkul et al. failed to ask the
crucial question, “Is sexual pleasure increased or
decreased by circumcision?” Another study, carried out
in a different culture (America) answers that question.
Denniston8 carried out a survey
of 38 adult males who were circumcised at least 2 years after
they commenced sexual intercourse. Thirteen men felt that sexual intercourse was
better after circumcision, but 22 felt that intercourse was
worse and would not have the circumcision again, because of
loss of sexual pleasure.

There are ethical concerns regarding the
nontherapeutic circumcision of minors.9 Elective circumcision should be
restricted to adult males who, after being fully informed of
the diminution of sensory input and pleasure associated with
circumcision, personally give their informed
consent.